Depok, 27 December 2025 – The Faculty of Public Health, Universitas Indonesia (FPH UI), continues to deliver meaningful scientific contributions to the strengthening of primary health care services in Indonesia. Dian Meutia Sari, a doctoral student in the Public Health Sciences Program at FPH UI, successfully defended her dissertation entitled “Development of the TAMI Instrument (insTrumen skrining PPOK pAda Masyarakat berIsiko) in Indonesia.” Through this research, Dian introduced a practical screening instrument designed to support the early detection of Chronic Obstructive Pulmonary Disease (COPD) in primary health care facilities.
This study addresses a persistent challenge in the field: early detection of COPD remains limited, despite the increasing burden of the disease as a chronic condition. At the same time, access to spirometry examinations is still restricted, and simple screening instruments that truly reflect the risk characteristics of the Indonesian population are not yet widely available. As a result, many COPD cases are only identified at more advanced stages, narrowing opportunities for early intervention.
Dian developed her dissertation using an exploratory sequential mixed-methods design, conducted in two stages. The first stage involved qualitative research through in-depth interviews to identify COPD risk factors most relevant to the Indonesian context and to develop the initial draft of the TAMI instrument. The second stage consisted of a quantitative case–control study involving 200 respondents from populations at risk of COPD, with spirometry used as the gold standard to assess the diagnostic performance of the instrument.
“I developed the TAMI instrument so that it can be practically used in primary health care settings to help identify individuals at risk of COPD at an early stage, while still taking into account risk factors relevant to the Indonesian population,” said Dian Meutia Sari.
The results showed that the TAMI instrument demonstrated good diagnostic performance, with an area under the curve (AUC) of 0.773. The study also reported that the sensitivity and specificity of TAMI were superior to those of the PUMA (Prevalence Study and Regular Practice, Diagnosis and Treatment Among General Practitioners in Populations at Risk of COPD) instrument, which has been nationally recommended by the Indonesian Pulmonology Society since 2022. In addition, TAMI showed higher positive predictive value (PPV) and negative predictive value (NPV), indicating better discriminative ability both in identifying COPD cases and in excluding non-COPD cases.
The main strength of the TAMI instrument lies in its integration of risk factors closely aligned with the realities of Indonesian society. TAMI incorporates smoking history—both current and former smokers, including conventional and electronic cigarettes—calculated using the Brinkman Index. The instrument also considers exposure to indoor air pollution, the level of dyspnea based on the modified Medical Research Council (mMRC) scale, and a history of asthma. This combination of factors makes TAMI more comprehensive while remaining practical for use in primary health care services.
The research supervisor, Prof. Dr. dr. Ratna Djuwita, M.P.H, emphasized that this study makes an important contribution to strengthening promotive and preventive approaches in primary health care, particularly in improving early detection of COPD. In addition to producing a valid and applicable screening instrument, the dissertation also developed a policy brief as a set of policy recommendations for the Ministry of Health to support COPD control efforts in Indonesia.
The doctoral promotion examination was chaired by a board of examiners consisting of Prof. Dr. Dra. Dumilah Ayuningtyas, M.A.R.S (Chair), Prof. Dr. dr. Ratna Djuwita, M.P.H (Supervisor), Prof. Dr. Besral, S.K.M., M.Sc and dr. Triya Damayanti, Ph.D., Sp.P(K) (Co-Supervisors), as well as examiners Prof. Dr. Dra. Evi Martha, M.Kes, Dr. rer. Medic. Putri Bungsu, S.K.M., M.Epid, Dr. Eva Susanti, S.Kp, M.Kes, dr. Arief Bakhtiar, Sp.P(K), FAPSR, and Dr. Ir. Chandra Rudyanto, MPH.
Dian Meutia Sari successfully defended her dissertation and was awarded the degree of Doctor of Public Health Sciences, graduating cum laude. She is the 31st doctoral graduate of 2025, the 370th doctoral graduate of the Public Health Sciences Program, and the 486th doctoral graduate of FPH UI overall. (promovendus/wrk)